Healthcare Provider Details

I. General information

NPI: 1073320651
Provider Name (Legal Business Name): JAN ALTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANICE H. ALTMAN

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 GLENSIDE DR STE B
RICHMOND VA
23228-3995
US

IV. Provider business mailing address

4518 BROMLEY LN # 2
RICHMOND VA
23221-1102
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-4300
  • Fax: 804-741-5300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002590
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: